Release of Records Form- Galvin Middle School

Wakefield Public SchoolsWakefield, MA 01880

In accordance with Chapters 71, 71B and Chapter 76 of the General Laws of the Commonwealth of Massachusetts, it is illegal to forward any school records without the permission of the student and/or parent.

I hereby authorize the Galvin Middle School to release all records, including the health record, relevant to the educational needs of:

Student's First Name *

Student's Last Name *

Year of Graduation *

School that Student Will Attend *

Street Address *

City *

State *

Zip Code *

Parent or Guardian, if student is under age 18; or the student if over age 18 *